Accuracy of Portable Chest Radiography in the Critical Care Setting

Lefcoe, Michael S.; Fox, George A; Leasa, David; Sparrow, Robbie; McCormack, David G.

doi:10.1378/chest.105.3.885

Cited by 80 publications

(16 citation statements)

References 6 publications

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“…We first evaluated the reliability and accuracy of the CXR for diagnosing pneumonia in our hemodialysis population. Interrater agreement for identifying a pulmonary infiltrate on CXR is not high in the general population, ranging from slight (κ = 0.27) to fair (κ = 0.37) (5, 6). In the hemodialysis population we found a similar interrater agreement (κ = 0.32).…”

Section: Discussionmentioning

confidence: 92%

“…In the hemodialysis population we found a similar interrater agreement (κ = 0.32). The sensitivity and specificity of the CXR for diagnosing pneumonia in the general population is reported to be 60% and 29%, respectively, when compared with protected bronchial brush cultures in patients suspected of having ventilator-associated pneumonia (5), and 32%–65% and 74%–93%, respectively, when compared with CT chest imaging in bedridden patients suspected of having pneumonia (7). In our hemodialysis population, we found similar results (sensitivity of 50% and a specificity of 57%–59%) when clinical adjudication was used to establish the diagnosis of pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have highlighted the limitations of both clinical findings and the CXR for diagnosing pneumonia in the general population (5–11), but the diagnosis of pneumonia has never been evaluated systematically in the dialysis population. Dialysis patients are specifically susceptible to volume overload and pulmonary edema, which may complicate the diagnosis of pneumonia.…”

Section: Introductionmentioning

confidence: 99%

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Pneumonia in hemodialysis patients: a challenging diagnosis in the emergency room

Judd

Ahmed²,

Harms³

et al. 2013

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Background Diagnosing pneumonia in hemodialysis patients is challenging. We hypothesized that pulmonary edema, which occurs commonly in hemodialysis patients, may frequently be misdiagnosed as pneumonia. Methods We retrospectively reviewed the records of 105 hemodialysis patients admitted with the diagnosis of pneumonia. Two experienced radiologists masked to the clinical course and subsequent imaging, independently interpreted the admission chest radiographs. In 68 of the patients, 2 internists independently reviewed the hospitalization records to diagnose pneumonia and pulmonary edema. The level of agreement among the radiologists was assessed using the kappa test. Using the clinical diagnoses, chest radiograph attributes were calculated. Logistic regression was performed to identify clinical and laboratory markers associated with pneumonia and pulmonary edema. Results The radiologist showed slight agreement on pneumonia (κ = 0.32) and pulmonary edema (κ = 0.28). Using clinical consensus, pneumonia was diagnosed in only 21% (14/68) of patients. Chest radiograph attributes for diagnosing pneumonia included: sensitivity 50%, specificity 58%, positive predictive value 25% and negative predictive value 81%. Pneumonia was associated with presenting temperature (odds ratio [OR] = 2.01; 95% CI, 1.03–3.93). Pulmonary edema was associated with shortness of breath (SOB) at admission (OR = 4.83; 95% CI, 1.25–18.6), presenting temperature (OR = 0.44; 95% CI, 0.21–0.92) and volume removed during hemodialysis (OR = 1.96; 95% CI, 1.16–3.31). Conclusions The admission chest radiograph has significant limitations when used to diagnose pneumonia in hemodialysis patients. A high presenting temperature supports the diagnosis of pneumonia, while a low presenting temperature, SOB and large volume ultra-filtration favor the diagnosis of pulmonary edema.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pneumonia in hemodialysis patients: a challenging diagnosis in the emergency room

Judd

Ahmed²,

Harms³

et al. 2013

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“…Lung contusion is a frequent clinical entity but often remains undiagnosed -especially upon first evaluation -because a diagnosis is unlikely with a visit and chest radiography 5,7,8 . Although Tc is the gold standard for lung contusion diagnosis, it is expensive and subjects the patient to the risks of transport, contrast agent side effects and radiation and is therefore non-viable for the seriate monitoring of the patient.…”

Section: Resultsmentioning

confidence: 99%

“…Rapid diagnosis and management of critical patients is strategic in the Emergency Department but hard in cases of unusual presentation or clinical abnormalities common to different pathologic conditions [2][3][4][5] . In our case report, careful anamnestic record, accurate physical examination and a few diagnostic tools -with the support of bedside-focused ultrasonography -allowed rapid diagnosis and effective treatment.…”

Section: Discussionmentioning

confidence: 99%